title: Dilute brimonidine to improve patient comfort and subconjunctival hemorrhage after LASIK.
abstract: OBJECTIVE
  To investigate whether dilute brimonidine (0.025%) reduces patient discomfort, subconjunctival hemorrhage, and injection after LASIK without a significant increase in the rate of flap complications or surgical enhancements.
  
  
  METHODS
  This randomized, double-blind, prospective study enrolled 180 patients (360 eyes) in a contralateral eye comparison of topical dilute brimonidine, naphazoline/pheniramine, or Systane Ultra (Alcon Laboratories, Inc., Fort Worth, TX) administered shortly before LASIK for any indication. Patients were evaluated for subconjunctival hemorrhage, injection, and flap dislocation 1 hour and 1 day postoperatively. Patient questionnaires measuring patient comfort and ocular symptoms were administered at these same follow-up visits. Patients were examined for 3 months to determine similar outcomes for standard indices of safety, predictability, efficacy, and enhancement rates.
  
  
  RESULTS
  Scores of patient discomfort, subconjunctival hemorrhage, and injection were significantly lower in eyes treated with dilute brimonidine at the 1 hour and 1 day postoperative examinations. Refloats for mild-flap edge wrinkling were required in 3 brimonidine eyes (2.5%), 1 naphazoline/pheniramine eye (0.8%), and no control eyes, but this difference did not reach statistical significance (P = .18). There was no significant difference between eyes at 3 months in terms of visual acuity, refractive error, corrected distance visual acuity, or rate of enhancement.
  
  
  CONCLUSIONS
  Use of dilute brimonidine before LASIK reduces subconjunctival hemorrhage and injection and improves patient comfort after surgery. Flap edge wrinkling requiring refloat may still be a complication with dilute brimonidine.
authors.affiliation: Durrie Vision, Overland Park, KS 66211, USA.
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Pasquali
authors.forename: Adam
authors.initials: A
authors.lastname: Aufderheide
authors.forename: Jason P
authors.initials: JP
authors.lastname: Brinton
authors.forename: Michele R
authors.initials: MR
authors.lastname: Avila
authors.forename: Erin D
authors.initials: ED
authors.lastname: Stahl
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Durrie
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000068438:Brimonidine Tartrate; D003229:Conjunctival Diseases / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005130:Eye Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006940:Hyperemia / Q000188:drug therapy / Q000209:etiology; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009278:Naphazoline / Q000627:therapeutic use; D017060:Patient Satisfaction; D010632:Pheniramine / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D011810:Quinoxalines / Q000627:therapeutic use*; D012029:Refraction, Ocular / Q000502:physiology; D054140:Refractive Surgical Procedures; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000316:Adrenergic alpha-Agonists; D006634:Histamine H1 Antagonists; D011810:Quinoxalines; D010632:Pheniramine; D000068438:Brimonidine Tartrate; D009278:Naphazoline